MAGIC
In resectable gastric, gastroesophageal-junction or lower oesophageal adenocarcinoma, does perioperative ECF improve survival over surgery alone?
Reported outcome visualization
Key results
Five-year OS was 36% with perioperative ECF versus 23% with surgery alone; HR for death 0.75 (95% CI 0.60–0.93; P=.009). PFS improved (HR 0.66, 95% CI 0.53–0.81; P<.001). R0 resection was 79% versus 70%.
Absolute Effect
Absolute 5-year OS gain 13 percentage points; NNT ≈8 for one additional survivor at 5 years, calculated from 1/0.13. This is a historical comparison against surgery alone, not modern FLOT.
NNT: ≈8, based on 5-year overall survival.
NNH: Not quantifiable from the verified fixed-time toxicity data used in this summary; see toxicity and treatment burden below.
Time-to-event interpretation: Hazard ratios and median survival are relative/time-to-event measures; they are not converted into NNT unless a fixed-time absolute event estimate is available.
Toxicity and treatment burden
Postoperative complications were similar (about 46% vs 45%) and 30-day postoperative mortality was similar. Only about 42% completed all six planned cycles; perioperative chemotherapy adds hematologic, gastrointestinal, renal and cardiac burden.
Follow-up, limitations and maturity
Follow-up: Median follow-up approximately 4 years in the primary report.
ECF is no longer the preferred contemporary perioperative regimen in many settings; limited D2 lymphadenectomy and low completion of postoperative treatment constrain transportability. FLOT4 later changed practice.
Clinical interpretation
Perioperative chemotherapy established a survival advantage over surgery alone, but MAGIC is foundational historical evidence rather than the current preferred regimen.
Primary publication and sources
Cunningham D, et al. N Engl J Med. 2006;355:11–20.
Current-practice context · reviewed 15 October 2026
MAGIC established perioperative chemotherapy over surgery alone, but ECF is not the preferred modern regimen for most fit patients. FLOT4 established perioperative FLOT as a more effective option than ECF/ECX in fit resectable gastric/GEJ adenocarcinoma; by 2026, MATTERHORN has further changed the perioperative evidence landscape through durvalumab plus FLOT. The original MAGIC absolute effect should remain clearly labelled as a historical surgery-alone comparison.
FLOT4 primary publication ↗ · 2026 position paper on MATTERHORN ↗